Mehl. bullets anxiety disorders + NBME 10 192Q. 04-06 (1) Flashcards
Mehl. USMLE might give 40-year-old woman who is worried about many things (e.g., her son going to college, her work, her marriage, etc.) for 6+ months. Dx?
GAD
Mehl. Ped. USMLE might give teenage girl who is worried about many things for 6+ months. Dx?
GAD
Mehl. USMLE will usually give patient with yperventilation, where he/she feels like he/she is going to die or is having an MI. Usmle can fool with what Dx?
ITS PANIC ATTACK
they want you to think its cardiac pathology
Mehl. Vignette can mention a mid-systolic click (mitral valve prolapse) + ask you the cause of the patient’s symptoms.
Panic disorder, not mitral valve prolapse.
Student is confused because they say, “But wait, the patient has a mid-systolic click though.” You’re right. But the MVP itself isn’t the cause of the patient’s presentation. MVPs are common in the population and almost always asymptomatic
Melh. panic disorder Tx? conservative
Breathing exercises to encourage the patient to stop hyperventilating.
Breathing into a paper bag is wrong answer. Often times they won’t have breathing exercises as an answer, where benzo is correct.
Melh. panic disorder Tx? drug?
Often times they won’t have breathing exercises as an answer, where benzo is correct.
Mehl. 22F + not performing well in classes since breaking up with boyfriend 3 months ago; sleeps well; no weight loss; has low mood; Dx?
adjustment disorder
Dx is socio-occupational dysfunction (school, work, social life) secondary to specific stressor, but patient must not have mood or psychotic disorder, otherwise Dx is, e.g., major depressive disorder (MDD), or bipolar, etc. Some Psych shelf questions will have as answers, e.g., “Adjustment disorder with depressed mood,” or “Adjustment disorder with anxious mood,” but in these vignettes the patient won’t have actual MDD or a true psychotic disorder.
Mehl. Tx of GAD? first line
cognitive behavioral therapy (CBT) and/or SSRI;
Mehl. Tx of GAD? second line
Second-line pharm agent is buspirone, which is a serotonin receptor agonist; USMLE wants you to know buspirone + its mechanism, but also remember that it’s not first-line for GAD; SSRIs are.
Mehl. 39F + >6-month Hx of multiple worries (i.e., career, marriage, kids going to college, etc.) + no overt mood or psychotic Sx; Dx?
generalized anxiety disorder (GAD)
Dx is >6 months of general worries without lack of specific stressor.
Mehl. Tx for OCD on shelf?
SSRI (i.e., sertraline).
Mehl. 16F + has mid-systolic click + episode of hyperventilation and chest pain and sense of impending doom; Dx?
panic attack = acute episode
Mehl. 16F + has mid-systolic click + episode of hyperventilation and chest pain and sense of impending doom + RECURRENT EPISODES. Dx?
Recurrent episodes = panic disorder.
if one - panic attack
Mehl. for panic disorder: psych shelf will often try to make vignette sound cardiac; sometimes “mitral valve prolapse” will be listed as a wrong answer; student will say, “but there’s a mid-systolic click,” which is true, but the answer is still panic attack/disorder; MVP is most common murmur in population + almost always benign finding
.
mehl. Tx of panic attack vs panic disorder?
panic attack: benzo on USMLE.
For panic disorder, Tx = SSRI.
Mehl. Fainting in panic disorder; why?
decreased cerebral perfusion,” or “cerebral
hypoperfusion”; hyperventilation -> decreased CO2 -> causes decreased cerebral blood flow.
mehl. USMLE can give a vignette of a child going to summer camp or school who gets stomach aches on arrival. Dx?
Separation anxiety disorder
Mehl. If Q gives you an asthma patient who has social phobia. Tx?
Choose benzo instead of propranolol.
They make this distinction on NBME.
NBME 10 192Q.
27y/o man + 3-month history of episodes of palpitations, light-headedness, and tightness in his chest and throat. During the episodes, he feels an impending sense of doom and fears that he might die or “go crazy.” For the past 6 weeks, he has worried constantly that there is something wrong with his heart and that the symptoms will recur. He recently ended a 3-year relationship. He is a high school teacher. Physical examination shows no abnormalities. Mental status examination shows an anxious affect. Which of the following is the most likely diagnosis?
Panic disorder
